Near Misses Recording

I recently had a good discussion with a pharmacy auditor about the recording of Near Misses in the dispensary.

No doubt I believe every pharmacy struggle to grasp the concept of Near Misses.  Is picking up an error during normal double checking procedure count as a Near Miss incident?

Medication error – confusion over Humalog insulins

Medication errors involving Humalog insulin products continue to occur in New Zealand hospitals.

Three Humalog products are currently available and funded in New Zealand: Humalog, Humalog Mix 25, and Humalog Mix 50. Errors continue to occur during the prescribing, dispensing and administration of these products.

Hypnotics and anxiolytics – a wake-up call

A recently released coroner’s report serves as a reminder to all healthcare professionals that the use of benzodiazepines and other hypnotics needs careful consideration when used for the treatment of insomnia.

Importantly, the duration of use and dose of hypnotics and benzodiazepines should be limited to a short course of treatment with regular review.

Quinine is not indicated for nocturnal leg cramps

Prescribers are reminded that quinine is no longer indicated for the treatment of leg cramps in New Zealand.¹

CARM continues to receive reports of adverse events associated with the use of quinine for leg cramps, indicating that a signi.cant number of patients are still being prescribed quinine for this off-label indication.

Reducing the risk of GI reactions with NSAIDs and/or COX-2 inhibitors

Non-selective non-steroidal anti-inflammatory drugs (NSAIDs) have varying degrees of anti­inflammatory, analgesic and antipyretic effects. These effects are related to the inhibition of the cyclo-oxygenase isoenzymes COX-1 or COX-2 that are involved in the production of prostaglandins and thromboxanes.¹

Iodine tablets for healthy pregnant and breastfeeding women

The Ministry of Health has recently issued advice to healthy pregnant and breastfeeding women to supplement their dietary intake of iodine.

The Ministry recommends that healthy pregnant and breastfeeding women take a daily 150 mcg iodine-only tablet from confirmation of pregnancy until the discontinuation of breastfeeding. This tablet should be taken in addition to eating well and choosing iodine-containing foods such as low-fat milk products, eggs, seafood, and commercially prepared bread.^1,2

SSRI & Serotonin syndrome/toxicity

Serotonin syndrome, more correctly termed serotonin toxicity, is a set of predictable type A dose dependent adverse reactions caused by increased intra-synaptic/extracellular serotonin.¹

Drug-induced QT prolongation and Torsades de Pointes – the facts

Prescribers are advised to consider the possibility of drug-induced QT prolongation or Torsades de Pointes (TdP) in patients presenting with new onset syncope, palpitations, seizures or resuscitated cardiac arrest.

QT prolongation, a surrogate marker for the risk of developing TdP, is an established side effect of Class I and Class III anti-arrhythmic medicines. It is also a rare side effect of a wide range of non-cardiac medicines including some antibiotics, antihistamines, opioid analgesics and complementary medicines.

Codeine & Breastfeeding

Healthcare professionals are reminded that codeine use by breastfeeding mothers has been associated with fatal cases of infant morphine toxicity. Healthcare professionals should carefully consider the risks and benefits of codeine before recommending its use to breastfeeding mothers.

Update on Employment Relations Act and Holidays Act

Are you aware of the changes to the Employment Relations Act and Holidays Act passed by Parliament this week? Most changes come into effect on 1 April 2011.

Key changes to the Employment Relations Act include:

Claiming for Faxed Prescriptions

A reminder about claiming in relation to faxed prescriptions.
The following is from the DHBNZ Pharmacy Procedures Manual of 1 March 2010:

“Section 4.1 Prescription Requirements
4.1.1 Prescriber Information
In addition to the legal requirements of a prescription, the following information is required for subsidy purposes:

Clexane Patient Support

Sanofi-Adventis stated that patients who use Clexane can access patient support items, including a patient education brochure, self injection technique DVD and a sharps container, from hospitals at no charge.

Pharmacy Audit – PQA4 Audit updates – Depots

Medicines Control issues authorities under Section 42(2)(a) of the Medicines Act for depots to possess prescription medicines so that they can hold prescriptions dispensed by a pharmacy for collection.

The PQA4 audit specifically requires a pharmacy supplying a depot to have documented SOPs. There must be clear documentation as to the expectations of the pharmacy from the depot(s) and what the depot can expect from the pharmacy. In particular, this includes:

Calcipotriol (Daivonex) is now a Pharmacist Only Medicine

Calcipotriol (Daivonex) is a prescription medicine, except in medicines containing not more than 50mcg/g or ml and when sold in a pack of not more than 30 gram or ml by a pharmacist to an adult with mild to moderate psoriasis previously diagnosed by a doctor.  This is not the same as a pharmacist-only classification, but the effect is similar – it can be sold by a pharmacist.

Definition of Dependant Child & Family Unit

Confused about entitilement to the the Family’s Community Services Card or Pharmaceutical Subsidy Card e.g. the children or other memebers of the family?

Protocol for Sale of Pharmacist Only Medicines

As per PSNZ’s Pharmacy Practice Handbook

3.2.15  Pharmacist Only Medicines (Restricted Medicines) New Zealand pharmacists have a unique professional opportunity to fulfil their roles as the ‘gatekeepers’ of non-prescription medicines (complementing their accepted role with prescription medicines) by providing the public with a particular group of medicines known as Pharmacist Only Medicines, or Restricted Medicines.  Pharmacist Only Medicine is the preferred term to use.

Buprenorphine clinical guidelines for treatment of opioid dependence

New Zealand Clinical Guidelines for the Use of Buprenorphine (with or without Naloxone) in the Treatment of Opioid Dependence

Ketamine is now a Controlled Drug !?!

A reminder that from 1 December 2010 ketamine is a Class C4 (Schedule 3 Part 4) controlled drug.